Questions to ask your provider about your pregnancy and labor

Here are some important questions to research and ask your provider when you're preggo rama. Feel free to add more in the comments section!

1. Ultrasounds- Once you've taken a preg test at home and called your provider, they usually bring you in around 10 weeks or so and then do an ultrasound to confirm around the same time. Ask your provider how many ultrasounds they usually perform. Typically, there's an ultrasound to confirm viable pregnancy around 10ish weeks and then another ultrasound at around 20 weeks to look at all the organs and gender (if you opt to find out). Thereafter, practices usually don't do any other ultrasounds unless you go past 40 weeks, then they need to check on amniotic fluid, also if there are any concerns/complications during pregnancy they will do another ultrasound. However, some providers will perform ultrasounds at every visit (that's almost every 2 weeks!) without medical reason or because of patient request. The issues with this is that, #1. it's costly, for either you or insurance companies, either way, they are a few hundred dollars a pop. #2. It's not completely known how "safe" ultrasound waves are for baby or if there's a "max" tolerance for the fetus, so why risk having numerous ultrasounds if the practitioner isn't looking for anything specific and if mom/baby are healthy? Question a provider who is ordering ultrasounds every visit to see if there's a reason.

2. Induction- When do they start talking about induction? Typically these days, practices let women go to 42 weeks (2 weeks past due date) until they induce. There are hospitals who are looking at inducing all women at 39 weeks to see if it reduces cesarean rates, be cautious about these practices, many women will go into labor on their own or will be induced at 42 weeks with a vaginal delivery. Induction typically is uncomfortable and can be hard on baby so shouldn't be looked at lightly. There are also natural ways to attempt to induce labor. Ask your provider if they are aware of these and have any recommendations on when to start a natural induction in hopes of avoiding a medical induction. However, sometimes you can do everything and still end up with induction or cesarean.

3. C-sections-  It is important to ask your provider, especially OBGYN what their cesarean rate is, that may give you an idea of what type of practice they have. For midwives, ask what the c-section rate is for the hospital, which will include their partnering OBGYNs. Be cautious about providers who tell you they don't do many c-sections, but their numbers tell a different story. If you've had a c-section before and are hoping for a vaginal delivery, years ago your hope for a vaginal delivery would be out the window, yet today vaginal births after cesarean (VBAC) are possible for many woman. If this is your wish, find a provider who does VBACs.

4. On call schedule- What is the call schedule for your provider? How large is the team they work with? Do they take other call, such as general gynecology surgery? There are some OBGYNs who will be on call for both labor and delivery and any gynecological surgery, which means that you could be in labor and the provider is in surgery doing a hysterectomy for example. What does this mean for you? You could be in a fast labor and progressing quickly, which means the staff will be doing everything they can to pull the OBGYN out of surgery. This puts a lot of stress on the nursing staff when things start moving quickly and the provider is unavailable.This also means you will get less face to face time with your provider.

5. Rooms- Make sure you take a tour of the labor and delivery area. Take note of how many beds there are and ask the ratio of patients to provider or patients to nurse, this will give you an idea of how much one on one time you can expect with your team. This is also why doula's are beneficial because they will be with you from the start. In the rooms are their tubs to utilize during labor, and can  you deliver in them, or only labor in them? Typically, if a bathtub is connected on the sides (like at your house), you won't be allowed to deliver the baby, but can stay in there and labor until you get the urge to push. Some hospitals have free standing tubs in each room if the mom opts for a water birth. Are there showers? Can you stay in the shower and labor? Do the rooms have birth balls or birth bars to utilize during labor?

6. Types of intervention- Is it hospital policy that you receive an IV? Do you have to be hooked up with a bag of fluids or can it be heplocked? Can  you opt out of an IV if you're medically stable and hydrated? All practices and hospitals are different, but if you want minimally invasive care during labor, see if you are able to opt out of an IV. It used to be standard practice to deny laboring mom's anything by mouth as far as food or drink, they would only give you ice chips. This practice has been looked at more closely and they realized that labor is hard work, like a marathon, and women need nutrition to keep their energy up! Ask your practice if they allow any type of food or drink during labor. Fetal monitoring- this is like a stretchy "belt" that goes around your stomach to listen and record the babies heart beat to make sure they are not in distress. Most practices require a minimum of 20 minutes monitoring in the beginning and then do intermittent monitoring with a doppler. Ask your practice if they would allow intermittent monitoring if baby has shown no distress. Does your practice use foreceps or vacuum extraction? This used to be a popular method of delivery years ago but has decreased for many reasons- these should be used only as a last resort effort to get the baby out vaginally. Does your practice routinely perform episiotomies (Surgical incision from the vagina down toward anus) or do they let you tear? Recent research has shown that women heal faster and better if they are allowed to tear naturally versus the practitioner making a cut. There are critical instances where an emergency cut becomes necessary to get baby out, but make sure it's not standard to do episiotomies.

7. The birth- When you're in the stage of pushing, is it typical for your practice to "count" or can you opt to push when your body tells you? Can you utilize any position that's comfortable for you to labor in (assuming you don't have an epidural, an epidural will limit your ability to get out of bed or walk, but you could utilize the chair position in bed.) Is your partner interested in "catching" the baby? Some practices absolutely do not let non-medical providers help catch the baby, while others do, if this is important to you or your partner, find out before you're in the delivery room. Does your practice do delayed cord clamping? This is becoming more standard of a lot of practices to wait to cut the umbilical cord when it stops pulsating, unless the baby is in distress or there's meconium in the fluid and they need to assess the baby immediately after delivery. It's also becoming standard practice to do skin to skin right after delivery (again if baby is not in distress). Is this standard practice for your provider? Can you delay the nursing assessment (ie: weight, footprints, and towel drying) until you've had time to bond and go skin to skin with baby?

8. After delivery, care of the baby- One important aspect that was brought to my attention is, once you deliver, you and your baby are two separate people, so there needs to be a pediatrician that discharges your baby from the hospital, which means they need to be affiliated with the hospital you're delivering at (get recommendations from your practice). Some pediatricians require a 48 hr stay for baby regardless. If you have the intentions of leaving the hospital sooner rather than later, opt for a provider who does not have the strict guidelines, that means you could leave 24-30 hours after delivery! Also, in regards to pediatricians, if you are considering delayed vaccines or are on the fence about any vaccines, make sure you pick a pediatrician who will respect those views. There are three things your baby will be offered in the hospital prior to discharge: 1. Hep B vaccine 2. Vitamin K injection 3. Erythromycin eye ointment. Do the research and if you decide you want to opt out of any, make sure you have a provider that will support this decision or who will at least talk to you about the advantages/disadvantages.

9. Birth plans-  Many people will tell you that birth plans never go as planned, however I believe that when a woman, especially a new mom puts together a birth plan it at least requires her to do research on what options there are. Know that when you develop a birth plan, it most likely won't go as perfectly as you hoped. Also make a plan for the emergency situations, such as in the event of an emergency c-section, is there anything you'd like? Partner to be handed the baby after delivery? Arms not tied down? Curtain lowered? Doula present in the surgical suite? There are still options for c-sections that allow women to be as much a part of birth as possible. You could also create a plan if the baby has to go to the NICU- who will be going with baby? If you have a provider that tells you to absolutely not create a birth plan, that may be a sign that he/she is not willing to look at alternative options you may wish for during your labor/delivery.

10. Natural birth- If you're hoping for a natural unmedicated birth, or to have aspects of your labor/delivery that utilize more natural methods, choose a provider who is educated and willing to work with you on this. Typically, midwives tend to be more versed in natural methods of labor and delivery, however there are many OBGYNs who are also versed and supportive, just make sure if this is your interest, you find a provider that is willing to work with you and also has the resources to help with an unmedicated  natural delivery.

The main thing is always ask questions! Just because the provider says or orders one thing does not mean you do not have other options.